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Osd Enrollment This Form Must Be Filled Out Before

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Executive Director Joe D. Cordova Commissioners Jack F. Tucker Lynda Collins Steve Shelton OSD Enrollment THIS FORM MUST BE FILLED OUT BEFORE ENROLLMENT IS COMPLETED AND BEFORE CHECKING IN TO THE DORM Student Name:____________________________ Grade:_______________________________ 1. Tables the MUST be visited and this form signed. _____ Student Assessment Center (Family Updates/Sorority/Grievance/Media/Medicaid, etc.) _____ Counselor _____ School Psychologist _____ IEP _____ Student Health Center _____ Dorm and Transportation _____ Student Finance _____Drivers Ed (Sophomores) 2. Take this form to the Coach’s table when completed. You will receive a ticket to get in to the dorm. __________________________________________ Coach’s signature 1100 East Oklahoma • Sulphur, Oklahoma 73086-3108 • Voice/TTY: (580) 622-4900 • Fax: (580) 622-4950 1100 East Oklahoma • Sulphur, Oklahoma 73086-3108 • Voice/TTY: (580) 622-4900 • Fax: (580) 622-4950 OKLAHOMA SECONDARY SCHOOL ACTIVITIES ASSOCIATION 7300 N. BROADWAY EXTENSION OKLAHOMA CITY, OKLAHOMA 73116 PHONE: 405-840-1116 FACSIMILE: 405-840-9559 _________________________________________________________________________________________________ SUDDEN CARDIAC AWARENESS INFORMATION SHEET The information outlined below is to serve as a guide in identifying sudden cardiac events and the importance of establishing an emergency protocol for sudden cardiac events. It is vitally important to act quickly, and appropriately when dealing with any issue dealing with cardiac arrest. All coaches, at all levels, as well as school administrators should be knowledgeable in the school’s protocol for dealing with such events. What is sudden cardiac arrest? Sudden cardiac arrest is a condition in which the heart suddenly and unexpectedly stops functioning. In turn blood stops flowing to the brain and other organs, and can result in death if not treated within minutes. What causes sudden cardiac arrest? The heart is a complex muscle that has an electrical system that controls the rate and rhythm at which the heart beats. Problems with that electrical system can cause arrhythmias, which can cause the heart to beat too fast or too slowly. An irregular heartbeat can be problematic, and in those cases the person has generally been made aware of the problem, however it can also go unnoticed, which is what makes a cardiac event so dangerous. Some conditions may be present at birth, or inherited while others may be an abnormality for an individual at birth but not inherited. Other conditions may not be present at birth, but developed later in life. What are the signs and symptoms? Fainting/dizziness Unusual fatigue Chest pain Shortness of breath Nausea/vomiting Increased heart rate beyond what is normal when exercising What is the treatment? Response time is critical when dealing with cardiac arrest. Call 911 immediately Begin CPR and or locate the nearest AED (automated external defibrillator) and begin the procedure for using the device. Can you screen for cardiac abnormalities? Yes, the student athlete could undergo an EKG. Below is the 12-step screening process from the American Heart Association. American Heart Association’s 12-step screening process: Personal history 1. Chest pain/discomfort upon exertion 2. Unexplained fainting or near-fainting 3. Excessive and unexplained fatigue associated with exercise 4. Heart murmur 5. High blood pressure Family history 6. One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50 7. Close relative under age 50 with disability from heart disease 8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, long QT syndrome which affects the heart’s electrical rhythm, Marfan syndrome in which the walls of the heart’s major arteries are weakened, or clinically important arrhythmias or heart rhythms. Physical examination 9. Heart murmur 10. Femoral pulses to exclude narrowing of the aorta 11. Physical appearance of Marfan syndrome 12. Brachial artery blood pressure (taken in a sitting position) What can I do to avoid cardiac arrest? Whether a heart condition is hereditary or not, or even with a healthy heart there are things that can be done to decrease the risks associated with a cardiac event. A healthy diet, including fruits and vegetables, and avoiding foods high in saturated fat and sodium will help. You should also avoid drinks high in sugar, such as soda and energy drinks. There is no better fluid replacement than water to avoid or combat dehydration. Energy drinks will increase the heart rate, so you should always avoid drinking anything that promotes an effect of increased energy. Daily exercise is also recommended to maintain a healthy heart. There is no better way to avoid a cardiac event than to be knowledgeable in your own family history, and live a healthy lifestyle that promotes good heart health. Develop an Emergency Plan specifically for cardiac arrest. Each school should develop an emergency plan specifically to deal with cardiac events. The plan should include the location of the nearest AED if available, as well as who will be in charge should the plan be put into action. Example: The head coach will immediately begin CPR and ask someone to call 911. Each school should develop a plan that will work for their respective school environment. While the plans for different schools may vary, no school should be without an emergency plan, which should be posted prominently. All school staff, including teachers, administrators, coaches, etc. should be trained in implementing the emergency plan. SUDDEN CARDIAC ARREST ACKNOWLEDGMENT SHEET Oklahoma School for the Deaf I, ______________________________, as a student-athlete who PLEASE PRINT STUDENT ATHLETE’S NAME) participates in Oklahoma School for the Deaf athletics and I, ____________________________________ as the parent/legal guardian, PLEASE PRINT PARENT/LEGAL GURADIAN’S NAME) have read the information material provided to us by OSD related cardiac awareness during participation in athletic programs and understand the content and warnings. SIGNATURE OF STUDENT-ATHLETE DATE SIGNATURE OF PARENT/LEGAL GUARDIAN DATE This form should be completed annually prior to the athlete’s first practice and/or competition and be kept on file for one year beyond the date of signature in the principal’s office or the office designated by the principal. OSSAA PHYSICAL EXAMINATION AND PARENTAL CONSENT FORM PLEASE PRINT DATE OF EXAM____________________________ Name_______________________________________________________________ Sex _________ Age ________________ Date of Birth __________________________________ Grade ______________ School __________________________________________________________________________ Sport(s) ______________________________________ Address ______________________________________________________________________________________________________ Phone ________________________________ Personal physician _____________________________________________________________________________________________ Phone ________________________________ In case of emergency, contact: Name ____________________________________________________________________________________________________________________ Relationship ____________________________________________________________ Phone (H) ________________________________ (W) _______________________________ Explain “Yes” answers below. Circle questions you don’t know the answers to. YES NO 1. Do you have an ongoing or chronic illness? 2. 3. Have you ever become ill from exercising in the heat? 9. Have you ever had surgery? Do you cough, wheeze, or have trouble breathing during or after activity? Are you currently taking any prescription or nonprescription (over-the-counter) medications or pills or using an inhaler? Do you have asthma? Do you have seasonal allergies that require medical treatment? 10. Do you use any special protective or corrective equipment or devices that aren’t usually used for your sport or position (for example, knee brace, special neck roll, foot orthotics, retainer on your teeth, hearing aid)? 11. Have you had any problems with your eyes or vision? Do you have any allergies (for example, to pollen, medicine, food, or stinging insects)? Have you ever had a rash or hives develop during or after exercise? 5. Have you ever had numbness or tingling in your arms, hands, legs, or feet? 8. Have you ever been hospitalized overnight? Have you ever taken any supplements or vitamins to help you gain or lose weight or improve your performance? 4. YES NO Have you had a medical illness or injury since your last check up or sports physical? Have you ever passed out during or after exercise? Do you wear glasses, contacts, or protective eyewear? 12. Have you ever been dizzy during or after exercise? Have you ever had a sprain, strain, or swelling after injury? Have you ever had chest pain during or after exercise? Have you broken or fractured any bones or dislocated any joints? Do you get tired more quickly than your friends do during exercise? Have you had any other problems with pain or swelling in muscles, tendons, bones, or joints? Have you ever had racing of your heart or skipped heartbeats? If yes, check appropriate box and explain below. Head Neck Back Chest Shoulder Upper arm Have you had high blood pressure or high cholesterol? Have you ever been told you have a heart murmur? Has any family member or relative died of heart problems or of sudden death before age 50? Have you had a severe viral infection (for example, myocarditis or mononucleosis) within the last month? 13. Do you have any current skin problems (for example, itching, rashes, acne, warts, fungus, or blisters)? 7. Have you ever had a head injury or concussion? Have you ever been knocked out, become unconscious, or lost your memory? Hip Thigh Knee Shin/calf Ankle Foot Do you want to weigh more or less than you do now? Do you lose weight regularly to meet weight requirements for your sport? Has a physician ever denied or restricted your participation in sports for any heart problems? 6. Elbow Forearm Wrist Hand Finger 14. Do you feel stressed out? 15. Record the dates of your most recent immunizations (shots) for: Tetanus _________________ Measles _________________________ Hepatitis ________________ Chickenpox ______________________ Explain “Yes” answers on a separate sheet. Have you ever had a seizure? Do you have frequent or severe headaches? The above information is correct to the best of my knowledge. I hereby give my informed consent for the above-mentioned student to participate in activities. I understand the risk of injury in athletic participation. If my son/daughter becomes ill or is injured, necessary medical care can be instituted by physicians, coaches, trainers or other personnel properly trained. I further acknowledge and consent that, as a condition for participating in activities, identifying information about the above-mentioned student may be disclosed to OSSAA in connection with any investigation or inquiry concerning the student’s eligibility to participate an/or any possible violation of OSSAA rules. OSSAA will undertake reasonable measure to maintain the confidentiality of such identifying information, provided that such information has not otherwise been publicly disclosed in some manner. Signature of parent/guardian _________________________________________________________________ Date __________________________________ Signature of athlete ________________________________________________________________________ PREPARTICIPATION PHYSICAL EVALUATION PLEASE PRINT DATE OF EXAM _____________________________ Name ___________________________________________________________Date of Birth _______________________________________ Height _______ Weight _______ Body fat (optional) _____% Pulse_______ BP _______/_______ (_______/_______, ______/_______) Initial BP Post Exercise 5 Min. Post Ex. Vision: R 20/_______ L 20/________ MEDICAL Appearance Eyes/Ears/Throat Lymph Nodes Heart Pulses Lungs Abdomen Genitalia (male only) Skin MUSCULOSKETAL Neck Back Shoulder/Arm Elbow/Forearm Wrist/Hand Hip/Thigh Knee Leg/Ankle Foot Corrected Y / N Normal Pupils: Equal ______ Unequal ______ Abnormal Findings CLEARANCE ( ) Cleared ( ) Cleared after completing evaluation/rehabilitation for: _________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ( ) Not cleared for: _________________ Reason: __________________________________________________________ ___________________________________________________________________________________________________ Recommendations: __________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Name & Title of Examiner (Print/Type) _____________________________________ Date _________________________ Address ____________________________________________________________ Phone__________________________ Signature of Examiner ______________________________________________________ OSSAA ELIGIBILITY RECORD FORM FOR NEW STUDENTS IN GRADES 7-12 (TO BE FILLED OUT BY THE STUDENT AND PARENT AND FILED IN PRINCIPAL'S OFFICE) NAME OF STUDENT (PRINT) ______________________________________________ Grade ______ Birth date ______________________ Age ____________ Student’s Current Address_______________________________________________________________________________________________________________ Last School attended __________________________________ Last School Address _________________________________________________ Zip___________ NOTE: STUDENT AND PARENT MUST SIGN BELOW AND EXPLAIN ALL “YES” ANSWERS FROM BELOW ON BACK OF FORM. YES NO 1. Will you be 14 years of age for 7th grade, 15 years of age for eighth grade, 16 years of age for ninth grade, or 19 years of age for high school participation before September 1? (Rule 1) 2. Have you missed school more than 10% of the school days taught for this 18-week grading period? (Rule 2) 3. Did you fail any classes during the last 18-week grading period? (Rule 3 & 4) 4. Are you currently failing any class? (Rule 3) 5. Were you ineligible to participate at any time during the last 18-week grading period? (Rules 3 & 4) 6. Have you done anything to jeopardize your amateur status such as receiving cash or merchandise connected with an athletic activity? (Rule 5) 7. Have you completed all 12th grade requirements for high school graduation? (Rule 6) 8. Have you failed any semesters (received no credit for the semester) since the time you entered the ninth grade? (Student’s are allowed 8 semesters from 9th-12th grades) (Rule 7) 9. Are you now or have you ever repeated any grade since entering the 7th grade? (Jr. High Rule 7) 10. Do you live with someone now other than whom you lived with last school year? (Rule 8) 11. Do you live with someone other than your parents? (Rule 8) 12. Do you live with only one parent? (Rule 8) 13. Do you live outside this school district? (Rule 8) 14. Is more than one residence owned, rented or maintained by your parents or guardian? (Rule 8) 15. Have you ever attended school outside the district where your parents reside? (Rule 8) 16. Are there other family members in grades K-12 attending a different school district other than the district you are now attending? 17. Have you ever participated at any school outside the district in which both parents had residence? (Rule 8) 18. Have you, your parents, or your guardians ever been influenced in any manner by anyone in this school district to attend this school to engage in athletics? (Rule 8) 19. Have you ever been granted athletic eligibility on the basis of an OSSAA hardship waiver? (Rule 19) 20. Were you on an approved foreign exchange program last year? (OSSAA policy) 21. Have you participated in a foreign exchange program for more than 365 days? (OSSAA policy) 22. Were you suspended, expelled, or under discipline at the previous school attended, or were you or your parents having a conflict with a coach, teacher, or administrator at the time you left your previous school? Each  of  the  undersigned  also  acknowledge  and  agree  that  identifying  information  about  the  above-­‐mentioned  student  may  be  disclosed  to   OSSAA  in  connection  with  any  investigation  or  inquiry  concerning  the  student’s  eligibility  to  participate  and/or  any  possible  violation  of   OSSAA  rules.    OSSAA  will  undertake  reasonable  measures  to  maintain  the  confidentiality  of  such  identifying  information,  provided  that  such   information  has  not  otherwise  been  publicly  disclosed  in  some  manner.   If the above guidelines are not satisfied for athletic eligibility, the student may be ineligible for one year. (See Rule 8) INCORRECT INFORMATION COULD CAUSE ELIGIBILITY TO BE REVOKED AND COULD RESULT IN THE FORFEITURE OF CONTESTS IN WHICH THE STUDENT HAS PARTICIPATED IN ADDITION TO OTHER PENALTIES. __________________________________________________ (Student) (Date) __________________________________________________ (Parent/Guardian) (Date) _______________________________________________ (Coach) (Date) PLEASE EXPLAIN ALL “YES” ANSWERS IN THE SPACE BELOW. FOR SCHOOL USE ONLY TO BE COMPLETED AND CERTIFIED BY SCHOOL ADMINISTRATION Each school must have the following information on file: 1. Copy of this eligibility record form. (Send copy to OSSAA office with hardship request.) 2. Physical examination and an annual parent consent form. (Rule 1) 3. Attendance record for current 18-week grading period. (Rule 2) 4. Transcript and any other documentation regarding student's eligibility status. If the student answers no to all of the above questions, you can be reasonably assured he/she is eligible (residence) to participate at your school. This is only an aid to the administrators concerning new students in your school system and does not automatically guarantee a student is eligible. If the student answers yes to any of the questions, further examination is required to determine eligibility status. NOTE: Any outstanding athlete transferring to your district should not be certified for athletic participation without complete information being obtained from all sources concerning the student's athletic eligibility. Based on the above questions (student's name - PRINT______________________________________ is eligible is not eligible to participate at (school)_______________________________________________________________________for the school year 20____ 20____. ______________________________________________________________ (School Administrator Name and Title) ______________ (Date) Concussion and Head Injury Acknowledgement Oklahoma School for the Deaf In compliance with Oklahoma Statue Section 24-155 of Title 70, this acknowledgement form is to confirm that you have read and understand the CONCUSSION FACT SHEET provided to you by Oklahoma School for the Deaf related to potential concussions and head injuries occurring during participation in athletics. For Student –Athlete: I, _______________________________, as a student-athlete who participates in Oklahoma School for the Deaf athletics have read the information material provided to us by Oklahoma School for the Deaf related to concussions and head injuries occurring during participation in athletic programs and understand the content and warnings. For Parent/Legal Guardian I,__________________________________, as the parent/legal guardian, have read the information material provided to us by Oklahoma School for the Deaf related to concussions and head injuries occurring during participation in athletic programs and understand the content and warnings. ________________________________________________________________ SIGNATURE OF STUDENT-ATHLETE DATE ________________________________________________________________ SIGNATURE OF PARENT/LEGAL GUARDIAN DATE This form should be completed annually prior to the athlete’s first practice and/or competition and be kept on file for one year beyond the date of the signature in the principal’s office of the office designated by the principal. CONCUSSION/HEAD INJURY FACT SHEET STUDENT-ATHLETE What is a concussion?       A concussion is a brain injury Is caused by a bump or blow to the head Can change the way your brain normally works Can occur during practice or games in any sport Can happen even if you have not been knocked out Can be serious if you have just been “dinged” WHAT ARE THE SYMPTOMS OF A CONCUSSION?          Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Does not “feel right” WHAT SHOULD I DO IF I THINK I HAVE A CONCUSSION?    Tell your coaches or parents. Never ignore a bump or blow to the head even if you feel fine. Also, tell your coach if one of your teammates may have a concussion. Get a medical checkup. A doctor of health care professional can tell you it you have a concussion and when you are OK to return to play. Give yourself time to get better. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a second concussion. Additional concussion can cause damage to your brain. It is important to rest until you get approval from a doctor or health care professional to return to play. HOW CAN I PREVENT A CONCUSSION?    Follow your coach’s rules for safety and the rules of the sport. Practice good sportsmanship. Use the proper equipment, including personal protective equipment (such as helmets, padding, shin guards and eye and mouth guards --- IN ORDER FOR EQUIPMENT TO PROTECT YOU, it must be the right equipment for the game, position and activity, and it must be worn correctly and used every time you play. FOR MORE INFORMATION VISIT:  www.cdc.gov/TraumaticBraininjury/  www.oata.net  www.ossaa.com  www.nfhslearn.com IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON! CONCUSSION/HEAD INJURY FACT SHEET PARENTS/GUARDIANS WHAT IS A CONCUSSION? A concussion is a brain injury. Concussions are caused by a bump or blow toe the head. Even “ding”, “getting your bell rung”, or what seems to be a mild bump or blow to the head can be serious. You cannot see a concussion. Signs and symptoms of a concussion can show up right after the injury or may not appear to be noticed until days of weeks after the injury. If you child reports any symptoms of a concussion or if you notice any symptoms yourself, seek medical attention right away. WHAT ARE THE SYMPTOMS REPORTED BY THE ATHLETES?          Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Does not “feel right” WHAT ARE THE SIGNS OBSERVED BY PARENTS/GUARDIANS?           Appears dazed or stunned Is confused about assignment or position Forgets an instruction Is unsure of game, score or opponent Moves clumsy Answers questions slowly Loses consciousness (even briefly) Shows behavior or personality changes Cannot recall events prior to hit or fall Cannot recall events after hit or fall HOW CAN I HELP MY CHILD PREVENT A CONCUSSION?    Ensure they follow coach’s rules for safety and the rules of the sport. Make sure they use the proper equipment, including personal protective equipment (such as helmets padding, shin guards and eye and mouth guards --- IN ORDER FOR EQUIPMENT TO PROTECT YOU, it must be the right equipment for the game, position and activity, and it must be worn correctly and used every time you play.) Learn the signs and symptoms of a concussion. FOR MORE INFORMATION VISIT:  www.cdc.gov/TraumaticBraininjury/  www.oata.net  www.ossaa.com  www.nfhslearn.com IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON! Oklahoma School for the Deaf Athletics 2015-2016 Academic Team November 5th-8th GPSD Academic Bowl TBA Here Football Schedule September 3rd Missouri 11:00 AM Away September 10th Depew 6:30 PM Away September 19th Louisiana 2:00 PM Home September 24th Kansas 10:00 AM Away October 3rd Mississippi 2:00 PM Home October 10th Iowa 2:00 PM Home October 14th Arkansas 11:00 AM Home Volleyball Schedule August 31st Noble 5:00 Home September 1st Tecumseh 5:00 Away September 2nd Missouri 7:00 Away September 8th Liberty Academy 5:00 Home??? September 17th Cement 5:00 Home September 19th Louisiana 9:00 AM Home September 21st Noble 5:00 Away September 22nd Tecumseh 5:00 Home September 23rd Kansas 7:00 Away October 3rd Mississippi 9:00 AM Home October 9th/10th GPSD TBA New Mexico? Basketball Schedule November 17th Milburn 6:30 Home November 30th Bray Doyle 6:30 Home December 4th – 5th Cajun Classic TBA Baton Rouge, LA December 8th Mill Creek 6:30 Away December 11th–12th Sunflower Classic TBA Olathe, KS December 15th Thackerville 6:30 Away January 5th Ryan 6:30 Home January 9th Arkansas Morning Away January 10th Kansas Afternoon Little Rock. AR January 11th Fox 6:30 Home January 19th Milburn 6:30 Away January 25th Bray Doyle 6:30 Away January 29th HOMECOMING 6:30 Home January 30th Missouri 6:30 Home February 1st Fox 6:30 Away February 2nd Springer 6:30 Home Febraury 8th Bennington 6:30 Home February 10th – 13th GPSD Tourn TBA Delavan, WI